Organization
1539 COUNTRY CLUB ROAD OPERATIONS LLC
Active
Other names
Tygart Center at Fairmount Campus
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BERG (SECRETARY)
(610) 444-6350
Entity
Organization
Contact information
Practice address
1539 COUNTRY CLUB RD, FAIRMONT, WV 26554-1306
(304) 366-9100
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 612-5327
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
62
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810013992
—
WV
Enumeration date
12/30/2008
Last updated
06/23/2025
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